Stories

Weighing the Alternatives: Complementary and Integrative Medicine Services at Kaiser Permanente Northwest

Stories - Aug 30 2018

Kaiser Permanente Northwest covers a range of complementary services—and the Center for Health Research plays a key role in understanding how well they work, how cost-effective they are, and what patients and doctors are saying about them.

By Charles Elder, MD
Senior Investigator, Kaiser Permanente Center for Health Research
Internal Medicine Physician, Northwest Permanente

In my 27 years of medical practice at Kaiser Permanente Northwest (KPNW), I have seen a strong and growing interest among patients in Complementary and Integrative Medicine (CIM) services. Indeed, data published from the Center for Health Research show that a majority of KPNW patients who have chronic musculoskeletal pain report having used a chiropractor or acupuncturist to help manage their condition.

Naturally, many patients are thus eager to see more CIM services—such as acupuncture, chiropractic care, naturopathy, and herb supplements—covered by their health insurance. The wide variety of available CIM services raises an important question: which ones should Kaiser Permanente cover?

On the one hand, KPNW wants to help and encourage patients to access CIM treatments that have been proven safe and effective. This position makes sense, given Kaiser Permanente’s commitment to meeting patients’ needs and delivering medical care that is supported by the best available evidence.

At the same time, physicians and leaders at KPNW understand that it makes no sense to cover alternative medicine services that have not been shown to be effective (or may even be dangerous). No one wants to waste resources. It’s also important to note that the temptation to use unproven or ineffective alternative therapies can sometimes harm patients by diverting them away from other types of conventional care that could be helpful.

For KPNW, deciding which CIM services to cover for members comes down to a relatively simple set of questions: What works? What doesn’t? What are the relative costs? Answering such questions requires careful, rigorous analysis—and that’s where the Center for Health Research plays a key role.

Below, I’ll provide a summary of the CIM services that KPNW currently offers, tell you what the data show about the effectiveness of these services, and share with you what patients and doctors have to say about it all.

From Chiropractic to Mind–Body Techniques: Covered CIM Services at KPNW

Many (though not all) Kaiser Permanente members have access to a variety of covered CIM services, including acupuncture and chiropractic care. Much of this care is provided by external referral to Complementary Health Plans (CHP), a KPNW-affiliated network that offers a reputable, professionally managed roster of acupuncturists, chiropractors, and other complementary medicine providers.

When a patient sees a KPNW physician, the doctor may decide to refer the patient to a CHP acupuncturist or chiropractor. Then, depending on the details of the patient’s coverage, the patient can be approved for a set number of visits with a CHP clinician. KPNW physicians can, and frequently do, refer patients to CHP acupuncturists for chronic musculoskeletal pain, and to CHP chiropractors for acute back or neck pain.

Many members purchase a rider that allows them to self-refer to a CHP clinician for any reason they choose. People who have this extra coverage can schedule to see a CHP acupuncturist or chiropractor on their own, without a referral from a KPNW doctor.

In addition, KPNW runs its own on-site CIM clinic at the West Interstate Medical Office. Staffed by experienced KPNW physicians, this program includes such therapies as diet, exercise, herb supplements, mind–body techniques, and other holistic approaches, prescribed in coordination with the usual conventional care. The clinic offers both group classes and individual appointments, and members can either come in to the clinic or connect online. This is a consultative service, so a referral from a KPNW doctor is required.

Are These Programs Working?

We provide CIM services to a lot of patients, so it is important to know how we are doing. Do the CIM therapies offered through KPNW provide good value and positive results? Let’s look at the data.

My colleagues and I recently published the results of a study that compared the effectiveness of standard medical care with and without the addition of chiropractic care. We recruited members with back or neck pain who had been referred for chiropractic care by their doctors. At the same time, we also identified and enrolled other patients who had visited the doctor for back or neck pain but had not been referred for chiropractic care. We then followed the two groups to compare how they did.

We found that both groups—patients who had been referred for chiropractic care and patients who simply continued with their usual care—showed significant improvements in their pain and disability over a three-month period.

The study also produced some surprises. Many people perceive that adding chiropractic care to a treatment regimen involves additional expense, but this turned out not to be true. Referring patients to see a chiropractor did not increase the cost of overall care. The data suggested that chiropractic care may have substituted for, rather than added to, other care within the system.

Additionally, many people have the impression that chiropractic care is a passive activity, with the patient just sitting there and receiving an adjustment. Again, this turned out not to be the case. Our data showed that most of the time, chiropractic care involves a great deal of self-care practice, including instructions for stretching, exercise, and the like. We also found that there were no serious safety concerns or side effects reported by the patients who saw the chiropractors.

The big takeaway from our study: Chiropractic care provided an additional clinically viable option for patients who prefer this type of care, at no additional expense.

What Do Patients, Doctors, and Chiropractors Have to Say?

The results I’ve shared here suggest that our chiropractic services can be a good choice for many patients, and that it is smart to include such care as part of our approach to helping patients with back and neck pain. But we know we need to do even better. 

In another CHR study, we reported on our findings from interviews done with KPNW patients and physicians, as well as both acupuncturists and chiropractors from CHP. People reported on the experience of providing, and receiving, CIM care through KPNW. All three groups agreed on one thing: that care could be greatly enhanced by opening the lines of communication between the doctors at KPNW and the acupuncturists and chiropractors at CHP.

Guided by the data from these CHR studies, KPNW leaders are already taking action. A new pilot program will test innovative ways of partnering KPNW clinicians with CHP chiropractors and acupuncturists, allowing for tighter coordination and improved sharing of information. This, in turn, will result in a more effective team and, ultimately, higher value and even better care for the patients. It’s a great example of how the data gathered through CHR research can inform the care delivered at KPNW, and improve the health of our members.